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Magnetic Resonance Imaging of Autoimmune Demyelinating Diseases as a Diagnostic Challenge for Radiologists: Report of Two Cases and Literature Review. Life (Basel) 2022; 12:life12040488. [PMID: 35454978 PMCID: PMC9027326 DOI: 10.3390/life12040488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 03/12/2022] [Accepted: 03/25/2022] [Indexed: 11/17/2022] Open
Abstract
The magnetic resonance characteristics of autoimmune demyelinating diseases are complex and represent a challenge for the radiologist. In this study we presented two different cases of detected autoimmune demyelinating diseases: one case of acute disseminated encephalomyelitis and one case of neuromyelitis optica, respectively. Expected and unexpected findings of magnetic resonance imaging examination for autoimmune demyelinating diseases were reported in order to provide a valuable approach for diagnosis. In particular, we highlight, review and discuss the presence of several uncommon imaging findings which could lead to a misinterpretation. The integration of magnetic resonance imaging findings with clinical and laboratory data is necessary to provide a valuable diagnosis.
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Ali A, Bareeqa SB, Riaz A, Ahmed SI, Shaikh MH, Ghauri MI. Assessment of Clinical Outcomes in Patients Presenting with Transverse Myelitis: A Tertiary Care Experience from a Developing Country. Cureus 2019; 11:e4342. [PMID: 31187007 PMCID: PMC6541160 DOI: 10.7759/cureus.4342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background: Transverse myelitis (TM) is an inflammatory disorder of spinal cord, characterized by acute or sub-acute dysfunction of spinal cord affecting the motor, sensory, and autonomic systems. It may be idiopathic or related to other diseases. Although some patients recover from TM with minor or no residual problems, others suffer permanent impairments that affect their ability to perform ordinary tasks of daily living. Our objective was to determine the frequency of different clinical outcomes in patients presenting with TM. Methods: It was a prospective cohort clinical study conducted from May 2018 till October 2018. Study was conducted in the Department of Neurology at Jinnah Medical College Hospital (JMCH), Karachi. In total 131 patients of TM were enrolled and treated as per standard protocol, and re-evaluated after eight weeks for assessment of clinical outcomes. Results: The average age of patients was 51.15 ± 6.56 years. Out of 131 cases, 36.6% of patients had full recovery and 63.4% had poor recovery while recurrence occurred in 66.7% cases. Urinary frequency was observed in 12.2% cases and incontinence in 6.9% cases. Conclusion: Acute TM has become transformed with recent developments, especially the advent of the MRI and the discovery of biomarkers.
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Affiliation(s)
- Aijaz Ali
- Neurology, Jinnah Medical College Hospital, Karachi, PAK
| | | | - Amir Riaz
- Rheumatology, Liaquat National Hospital and Medical College, Karachi, PAK
| | - Syed Ijlal Ahmed
- Internal Medicine, Liaquat National Hospital and Medical College, Karachi, PAK
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de Seze J, Lebrun C, Stojkovic T, Ferriby D, Chatel M, Vermersch P. Is Devic's neuromyelitis optica a separate disease? A comparative study with multiple sclerosis. Mult Scler 2016; 9:521-5. [PMID: 14582780 DOI: 10.1191/1352458503ms947oa] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Devic's neuromyelitis optica (NMO) associates optic neuritis and myelopathy without other neurological signs. Many patients with NMO may be diagnosed as having multiple sclerosis (MS). However, there have been no previous studies comparing these two patho logies and it is still unclear if NMO is a separate entity or a subtype of MS. In the present study, we compared a series of NMO patients with a series of MS patients for whom optic neuritis or myelopathy was the presenting symptom, in order to determine the place of NMO in the spectrum of MS. We retrospectively studied 30 patients diagnosed with NMO and we compared these patients with 50 consecutive MS cases revealed by optic neuritis or acute myelopathy. MS patients were only included if a relapse occurred demonstrating time and space dissemination. We compared the two groups in terms of clinical presentatio n, laboratory findings (MRI and C SF) and clinical outcome. NMO patients were older and more frequently women than MS patients but the difference was not significant. C SF and MRI data were clearly different: oligoclonal bands (O C B) were found in 23% of NMO cases and 88% of MS (P B/0.001), abnormal brain MRI data were observed in 10% of NMO cases and 66% of MS (P B/0.001) and a large spinal cord lesion was observed in 67% of NMO cases and 7.4% of MS cases (P B/0.001). C linical outcome was evaluated as more severe in the NMO group (P B/0.001). O n the basis of clinical data, all NMO patients but three had dissemination in time and space. When we included MRI parameters, only two of the NMO patients met criteria for MS and one of the MS patients met criteria for NMO. O ur study demonstrates that NMO and MS should be considered as two different entities. The respective criteria for NMO and MS were able to distinguish these two patho logies but only when MRI data were applied. This finding could have implications for future therapeutic trials.
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Affiliation(s)
- J de Seze
- Department of Neurology, Hôpital R. Salengro, University of Lille, France.
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Meyer P, Leboucq N, Molinari N, Roubertie A, Carneiro M, Walther-Louvier U, Cuntz-Shadfar D, Leydet J, Cheminal R, Cambonie G, Echenne B, Rondouin G, Deiva K, Mikaeloff Y, Rivier F. Partial acute transverse myelitis is a predictor of multiple sclerosis in children. Mult Scler 2014; 20:1485-93. [DOI: 10.1177/1352458514526943] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Acute transverse myelitis (ATM) in children is a rare and often severe disease for which there are few known prognostic factors, particularly the subsequent risk of multiple sclerosis (MS) diagnosis. Objectives: To determine the clinical course and prognostic factors after a first episode of ATM in children. Methods: Thirty children below 16 years of age diagnosed with a first neurological episode of ATM were included retrospectively. Clinical evaluation, treatment, laboratory, and MRI data were collected. Results: Median age at onset was 11 years (range 3–15 years). Follow-up data were available for a median of 4 years (range 0.5–16.7 years). Five patients subsequently had a diagnosis of MS (17%), which was associated with acute partial transverse myelitis (odds ratio 5; 95% confidence interval 2.3–11), with a 60% probability of having a relapse at five years ( p < 0.01). The 2011 Verhey criteria correctly identified MS in children with the highest specificity (96%) and sensitivity (80%). Conclusion: Acute partial transverse myelitis and brain MRI abnormalities at initial presentation are significantly predictive of a subsequent diagnosis of MS in children with ATM. These findings suggest that closer brain MRI monitoring after acute partial transverse myelitis might make the earlier introduction of disease-modifying therapies possible.
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Affiliation(s)
- P Meyer
- CHRU Montpellier, Neuropédiatrie, France
- INSERM U1046, Université Montpellier 1, Université Montpellier 2, France
| | - N Leboucq
- CHRU Montpellier, Neuroradiologie, France
| | - N Molinari
- CHRU Montpellier, Service DIM, Université Montpellier 1, UMR 729 MISTEA, France
| | - A Roubertie
- CHRU Montpellier, Neuropédiatrie, France
- INSERM U1051, Institut de Neurosciences de Montpellier, Université Montpellier 1, Université Montpellier 2, France
| | - M Carneiro
- CHRU Montpellier, Neuropédiatrie, France
| | | | - D Cuntz-Shadfar
- CHRU Montpellier, Neuropédiatrie, France
- CHRU Montpellier, Neurophysiologie Clinique, France
| | - J Leydet
- CHRU Montpellier, Neuropédiatrie, France
| | - R Cheminal
- CHRU Montpellier, Neuropédiatrie, France
| | - G Cambonie
- CHRU Montpellier, Réanimation Pédiatrique, France
| | - B Echenne
- CHRU Montpellier, Neuropédiatrie, France
| | - G Rondouin
- CHRU Montpellier, Neurophysiologie Clinique, France
| | - K Deiva
- AP-HP, CHU Bicêtre, Neuropédiatrie, Le Kremlin-Bicêtre, France
- National Referral Center for Neuro-Inflammatory Diseases in Children, Le Kremlin-Bicêtre, France
| | - Y Mikaeloff
- AP-HP, CHU Bicêtre, Unité de Rééducation Neurologique Infantile, Le Kremlin Bicêtre, France
- INSERM U669, Université Paris Sud11, France
| | - F Rivier
- CHRU Montpellier, Neuropédiatrie, France
- INSERM U1046, Université Montpellier 1, Université Montpellier 2, France
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Affiliation(s)
- Shin C. Beh
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, 5323, Harry Hines Blvd, Dallas, TX 75390, USA
| | - Benjamin M. Greenberg
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, 5323, Harry Hines Blvd, Dallas, TX 75390, USA
| | - Teresa Frohman
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, 5323, Harry Hines Blvd, Dallas, TX 75390, USA
| | - Elliot M. Frohman
- Department of Neurology and Neurotherapeutics, University of Texas Southwestern Medical Center, 5323, Harry Hines Blvd, Dallas, TX 75390, USA
- Department of Ophthalmology, University of Texas Southwestern Medical Center, 5323, Harry Hines Blvd, Dallas, TX 75390, USA
- Corresponding author. Multiple Sclerosis Clinical Care Center, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235.
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Awad A, Stüve O. Idiopathic transverse myelitis and neuromyelitis optica: clinical profiles, pathophysiology and therapeutic choices. Curr Neuropharmacol 2012; 9:417-28. [PMID: 22379456 PMCID: PMC3151596 DOI: 10.2174/157015911796557948] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Revised: 04/18/2010] [Accepted: 04/19/2010] [Indexed: 12/05/2022] Open
Abstract
Transverse myelitis is a focal inflammatory disorder of the spinal cord which may arise due to different etiologies. Transverse myelitis may be idiopathic or related/secondary to other diseases including infections, connective tissue disorders and other autoimmune diseases. It may be also associated with optic neuritis (neuromyelitis optica), which may precede transverse myelitis. In this manuscript we review the pathophysiology of different types of transverse myelitis and neuromyelitis optica and discuss diagnostic criteria for idiopathic transverse myelitis and risk of development of multiple sclerosis after an episode of transverse myelitis. We also discuss treatment options including corticosteroids, immunosuppressives and monoclonal antibodies, plasma exchange and intravenous immunoglobulins.
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Affiliation(s)
- Amer Awad
- Department of Neurology, Case Western Reserve University, Cleveland, OH, USA
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Eckstein C, Saidha S, Levy M. A differential diagnosis of central nervous system demyelination: beyond multiple sclerosis. J Neurol 2011; 259:801-16. [DOI: 10.1007/s00415-011-6240-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Revised: 08/28/2011] [Accepted: 08/30/2011] [Indexed: 12/12/2022]
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Alper G, Petropoulou KA, Fitz CR, Kim Y. Idiopathic acute transverse myelitis in children: an analysis and discussion of MRI findings. Mult Scler 2010; 17:74-80. [PMID: 20858691 DOI: 10.1177/1352458510381393] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is lack of reported magnetic resonance imaging (MRI) studies of idiopathic acute transverse myelitis (ATM) in children. OBJECTIVE To describe the imaging features of idiopathic ATM in children. METHODS We retrospectively analyzed the spinal MRI findings of children diagnosed with ATM. The anatomic regions, vertebral segmental length, gray or white matter involvement, cord expansion and gadolinium enhancement were examined. RESULTS A total of 27 children were diagnosed with isolated monophasic ATM with a mean follow-up of 5.2 years. Two children later diagnosed with neuromyelitis optica were excluded from the pediatric ATM cohort. None of the patients had a subsequent diagnosis of multiple sclerosis. The mean age of onset was 9.5 years (0.5-16.9 years). Spinal MRIs were abnormal in 21 (78%). The mean interval between symptom onset and the MRI was 1.7 days (0-19 days). Central cord hyperintensity involving gray matter was seen in all patients. A majority (67%) of the patients demonstrated long segment lesions with a mean segment length of 6.4. CONCLUSIONS We conclude that central cord inflammation extending over three or more segments is the most common finding of idiopathic monophasic transverse myelitis in children. The risk of multiple sclerosis in children who experience isolated transverse myelitis as a first demyelinating event is low.
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Affiliation(s)
- Gulay Alper
- Division of Child Neurology, Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, USA.
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Abstract
PURPOSE OF REVIEW Neuromyelitis optica is a severe inflammatory disease with selective involvement of the optic nerve and spinal cord and relative sparing of the brain. This paper will review the recent literature on neuromyelitis optica with special reference to the recently proposed changes in the diagnostic criteria and the broadening clinical spectrum of the disease. RECENT FINDINGS The revised proposed diagnostic criteria of neuromyelitis optica allow incorporation of the status of the recently discovered autoantibody, NMO-IgG, and the presence of brain abnormalities shown by magnetic resonance imaging. NMO-IgG has been found to have good sensitivity and specificity in distinguishing neuromyelitis optica from multiple sclerosis. About 60% of neuromyelitis optica patients can develop such brain abnormalities not typical of multiple sclerosis. The visual prognosis and ambulatory outcome of neuromyelitis optica is poor, and early, aggressive treatment may be warranted to prevent relapses resulting in severe disability. SUMMARY The clinical spectrum of neuromyelitis optica has expanded since the original description of the disease. Clinicians need to be aware of the recent developments in the diagnostic approach to neuromyelitis optica.
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Acute transverse myelitis with normal brain MRI. J Neurol 2007; 255:89-93. [DOI: 10.1007/s00415-007-0686-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2006] [Revised: 06/17/2007] [Accepted: 06/21/2007] [Indexed: 10/22/2022]
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Abstract
Several terms are now commonly used to describe various presentations of idiopathic myelitis, including acute transverse myelitis, acute partial transverse myelitis, and secondary myelitis. Ideally, a classification system would be able to encompass various presentations in a manner that not only assists in prognosis, but also in treatment decisions. Unfortunately, we are limited in our ability to accurately identify those patients who will progress to develop multiple sclerosis, Devic's syndrome, relapsing myelitis, or will remain monophasic. However, general principles are emerging that assist in prognosis based on the particular presenting features of any patient. We review the most recent criteria proposed for various forms of transverse myelitis and highlight the limitations of these classification schemes.
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Affiliation(s)
- Thomas F Scott
- Department of Neurology, Drexel University College of Medicine, Allegheny General Hospital, Pittsburgh, PA 15212, USA.
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Scott TF, Kassab SL, Singh S. Acute partial transverse myelitis with normal cerebral magnetic resonance imaging: transition rate to clinically definite multiple sclerosis. Mult Scler 2005; 11:373-7. [PMID: 16042216 DOI: 10.1191/1352458505ms1194oa] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine the long-term risk of developing clinically definite multiple sclerosis (CDMS) in patients with acute partial transverse myelitis (APTM) and normal cerebral magnetic resonance imaging (MRI) scans. METHODS We retrospectively studied 30 consecutive patients with clinical evidence of APTM. Patients with symmetric severe acute transverse myelitis were considered to have complete transverse myelitis and were excluded. All patients underwent spinal and cerebral MRIs, 13 underwent cerebrospinal fluid analysis and 11 patients underwent evoked potential studies. Various other studies were performed to assess for connective tissue disease and causes of APTM other than demyelinating disease. RESULTS After an average follow-up of 61 months, all laboratory and clinical evidence, including relapse history, indicated that three patients developed lesions on cerebral MRI and could be classified as CDMS by either Poser criteria (two patients) or MacDonald criteria (one patient). Relapses limited to the spinal cord seen clinically were seen in 14/30 (46.6%) patients. Oligoclonal bands were seen in 8/13 (62%) patients; one patient transitioned to CDMS. Unifocal lesions of the cord were seen in 19/30 (63%) patients, multifocal lesions were seen in 8/30 (27%) and 3/30 (10%) had negative MRIs. The three patients who converted to CDMS did so within five years of the onset of myelitis. CONCLUSION APTM with normal cerebral MRI had a low rate of conversion to CDMS in this long-term study. To date, there have been only a few follow-up studies that have addressed this issue.
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Affiliation(s)
- Thomas F Scott
- Drexel University College of Medicine, Allegheny General Hospital, Pittsburgh, PA 15212, USA.
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de Seze J, Stojkovic T, Ferriby D, Gauvrit JY, Montagne C, Mounier-Vehier F, Verier A, Pruvo JP, Hache JC, Vermersch P. Devic's neuromyelitis optica: clinical, laboratory, MRI and outcome profile. J Neurol Sci 2002; 197:57-61. [PMID: 11997067 DOI: 10.1016/s0022-510x(02)00043-6] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Devic's neuromyelitis optica (NMO) associates optic neuritis and myelitis without any other neurological signs. Many patients with NMO may be diagnosed as having multiple sclerosis (MS), optic neuritis and myelitis being the inaugural symptom in 20% and 5% of MS cases, respectively. The aim of our study was to compare a new NMO cohort with recent studies and to try to determine the place of NMO in the spectrum of MS. We retrospectively studied 13 patients with a complete diagnostic workup for NMO. We compared our data with the most recent studies on NMO and with the criteria proposed by Wingerchuck et al. [Neurology 53 (1999) 1107]. We also determined whether these patients fulfilled the diagnostic criteria for MS. Thirteen patients (10 women and three men, with a mean age of 37.4 years) were included in the study. We found similar results to previously published data, except for an association with vasculitis in 38% of our cases. All but three of the patients fulfilled the clinical criteria for MS and two patients fulfilled both clinical and MRI criteria for MS. However, if we applied more restrictive criteria concerning spinal cord and brain MRI and CSF, none of our NMO patients fulfilled the MS diagnostic criteria. NMO might therefore be differentiated from MS by the application of more stringent criteria. Furthermore, all NMO patients should be investigated for vasculitis, even those with no history of systemic disease.
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Affiliation(s)
- J de Seze
- Department of Neurology, Hôpital R. Salengro, CHRU de Lille, 59037 Cedex, Lille, France.
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